Knicks Joakim Noah suspension and SARMS

I am, painfully, a hardcore New York Knick basketball fan. They have been horrific all year so I have not tuned in much. As good as Phil Jackson was as a basketball head coach winning eleven championship rings, is as pathetic he is as a general manager of the Knicks. To culminate Jacksons distratrous performance, he gave Joakim Noah, a mediocre / poor player a four-year, $72 million contract. I feel like throwing up when I say that. Noah is injury prone recovering from knee surgery and recently on a 20 game suspension for using an illegal substance called LGD-4033.

LGD-4033 is a very powerful selective androgen receptor modulators (SARMS) which has found its way into illicit distribution. There are numerous websites selling SARM compounds but I would exercise caution with the use of the chemicals at this point. SARMS \ are prohibited by the World Anti-Doping Agency (WADA) and that’s way Noah has been penalized by suspension and $3 million fine.

What are SARMS?

SARMS are non-steroidal ligands ( molecules that bind to other molecules) that attach with selective androgen receptors (AR) and produce steroid-like results minus the steroids.

Who benefits from SARMS?

Patients with advanced cancer who are losing rapid weight may benefit the use of SARMS. Weight loss by muscle wasting (medically known as cachexia) in cancer is never a good thing as it increases the likelihood of premature death by up to 20%. There is currently a phase 3 randomized trial looking at the use of enobosarm (one of many SARMS in the market) for cachexia prevention in cancer patients. So far, smaller studies have shown promise in muscle wasting prevention in those with advanced malignancies.

Toxicity of chemotherapy is less prominent when a patient has more muscle mass. That is why I promote weight resistant exercises three to four times a week. Weight training is more important than just doing cardio exercises like running. They are both good, but if you have to choose one, let it be weight resistance training.

More muscle is a good thing, way beyond looking good. It helps with:

  • Improved insulin sensitivity requiring less insulin to metabolize sugars

(too much insulin is a problem for cancer and all health)

  • More sugar taken out from our blood by muscles and used for muscle

energy, resulting in less roaming sugar and insulin feeding cancer cells.

  • Weight resistance training increases IGFBP-3 (a good thing) , whichbinds to insulin-like growth factor (IGF), decreasing its ability to promote cancer (growth factors are normal within the human body, but too many can lead to excessive cellular growth, including cancer growth)7
  • Decreased inflammation (which by now you may know less is more)
  • Increased antioxidant defense, which protects your cells from DNA damage and oxidative stress
  • Strength and the stronger you are the longer you live.

Back to SARMS…

SARMS hold promise for promoting muscle gain for people with functional limitations associated with aging and chronic disease, frailty, cancer cachexia, and osteoporosis. What makes these chemicals different is that they are anabolic but not androgenic.

What do I mean by anabolic but not androgenic?

Anabolic by definition, builds up, in this case, muscle. (The opposite is catabolic, breaking down)

Androgenic is derived from the Greek words “andros” (man) and “genein” (to produce).and pertains to the development of male characteristics, including body hair, facial hair , prostate formation and growth and penis development.

Due to the enormous muscle and bone anabolic properties of SARMS have potential for misuse among professional athletes looking for a competitive edge ( or recovery from injury) which has led to the inclusion of SARMS into the World Anti-Doping Agency’s (WADA’s) Prohibited List in 2008. (Thevis & Shanzer, 2017)

LGD-4033

LGD-4033, also called Ligandrol or Anabolicum, has been through multiple human trials (most SARMS have been studied on animals), with interesting results:

One is a placebo-controlled study of 76 healthy men (21-50 years),  randomized to placebo or 0.1, 0.3, or 1.0 mg LGD-4033 daily for 21 days. LGD-4033 was safe, and increased lean body mass even during this short period without change in prostate-specific antigen (PSA).

LGD-4033 is not the only SARMS being studied. This blog site from my friends at bulletproof lists others being looked at scientifically.

My Take on SARMS and LGD-4033

I am biased on putting the work in to improve Testosterone (T) levels, gain musculature and strength with dedicated strength training exercises, good eating, key nutrients and botanicals. However, I know some people are starting at zero and need a pharmacological boost sometimes.

I am an agnostic doctor. I care for what works best for patients.

For example, some obese patients I have seen have extremely low T levels ( visceral fat makes estrogen do to the enzyme aromatase found heavily in fat) where exogenous testosterone cypionate helped with, not only building muscle and losing fat but with quality of life.

The problem is, of course, patients taking exogenous T need to be closely monitored by a physician who knows what they are doing as side effects from too much hormone include: too much red blood cell production, stimulate prostate growth by too much conversion to Dihydrotestosterone (DHT) and may be too androgenic – not a good thing if you are a women.

SARMS , however, just seem to build muscle and bone strength without side effects from exogenous T. I am specifically excited for the potential use of SARMS in patients whose muscles are wasting from cancer. The frail elderly population can also benefit from the use of these substances since muscle wasting (sarcopenia) is a major cause of death among those up there in calendar years.

I am keeping a close eye on the benefits of SARMS so stay tuned.

Meanwhile, I hope the Knicks tank the rest of the season and get a good draft pick for 2018. That would give me and Spike Lee some optimism.